title: Primary retroperitoneal lymph node dissection in low-stage testicular germ cell tumors: a detailed pathologic study with clinical outcome analysis with special emphasis on patients who did not receive adjuvant therapy.
abstract: OBJECTIVE
  To evaluate, in detail, the histopathologic features of metastatic testicular germ cell tumors to retroperitoneal lymph nodes treated with primary retroperitoneal lymph node dissection (RPLND) and correlate the findings with patients' outcomes.
  
  
  METHODS
  We studied 183 patients with documented pathologic stage II disease with or without elevated serum tumor markers, selected from 453 patients who underwent primary RPLND at our institution from 1989 to 2002. Tumor type(s), size and extent of disease, and amount of tumor necrosis were assessed and correlated with outcome.
  
  
  RESULTS
  Embryonal carcinoma was the most common tumor type, present as the only component in 99 cases (54%) and the predominant tumor type (>50%) in 142 (78%). The number of positive lymph nodes ranged from 1 to 40 from a total of 2-80 lymph nodes examined (median, 28). Extranodal extension (ENE) was identified in 120 cases (66%). Among 73 patients followed up expectantly and with normal serum tumor markers, 19 experienced relapse, the probability of which was higher in patients with more positive nodes, larger metastases, and presence of ENE. However, none of these differences was statistically significant (all P >.2). The predominance of embryonal carcinoma and the presence of tumor necrosis were not significantly associated with outcome.
  
  
  CONCLUSIONS
  In this cohort, most patients treated with primary RPLND and with positive lymph nodes also had ENE. We did not identify any variables to be significantly associated with relapse after RPLND in patients managed expectantly. Additional studies with more patients are needed to validate our findings.
authors.affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Hikmat A
authors.initials: HA
authors.lastname: Al-Ahmadie
authors.forename: Brett S
authors.initials: BS
authors.lastname: Carver
authors.forename: Angel M
authors.initials: AM
authors.lastname: Cronin
authors.forename: Semra
authors.initials: S
authors.lastname: Olgac
authors.forename: Satish K
authors.initials: SK
authors.lastname: Tickoo
authors.forename: Samson W
authors.initials: SW
authors.lastname: Fine
authors.forename: Anuradha
authors.initials: A
authors.lastname: Gopalan
authors.forename: Jason
authors.initials: J
authors.lastname: Stasi
authors.forename: Farhang
authors.initials: F
authors.lastname: Rabbani
authors.forename: George J
authors.initials: GJ
authors.lastname: Bosl
authors.forename: Joel
authors.initials: J
authors.lastname: Sheinfeld
authors.forename: Victor E
authors.initials: VE
authors.lastname: Reuter
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D018236:Carcinoma, Embryonal / Q000097:blood / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000473:pathology* / Q000601:surgery; D012187:Retroperitoneal Space; D018239:Seminoma / Q000097:blood / Q000473:pathology / Q000601:surgery; D013736:Testicular Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor